Trigger warning: mentions chest and chest dysphoria

I've been wondering this for a while. Is it possible to lose enough fat in your chest and shrink it to a size suitable for periareolar (keyhole) top surgery instead of double incision?

Right now I'm a C cup so I'm not too big but big enough to need D.I. In the past when my weight has fluctuated a little I dropped down to a B cup. I just started on a ketogenic diet too which burns body fat so I could lose the feminine fat patterns around my hips and I plan to lower my overall body fat percentage to about 12% then start bulking up on muscle. I figured that since I can't start T yet I may as well reshape what I have to work with for now then when I do start T it'll enhance the muscle building and help reduce my chest even more.

What about the extra skin in the chest from fat loss that would need to go to leave a flat chest?  My chest deflated significantly from T and weight loss, but they turned into sad empty sacks of skin. 

Skin is not that elastic, so unless you want to fill up the empty space with sizable, curved man pecs that look like the thing you are trying to erase, I don't know that it would be possible to get peri without it looking weirder than it would with DI scars.

I may be completely wrong, so take that into account too.  Keep working out though - that is great no matter what surgery you get.

I'd say it's possible, but I wouldn't bank on it. If, when you were thinner/lighter, you think your chest was small enough for peri and you think you could get back there again, you might be able to do peri instead. But as spacerace said, there's also the issue of excess skin and elasticity.

If you've been bigger for awhile, and/or if you have a lot to lose, there's not much chance of your chest skin shrinking back adequately. I've found that as I've lost weight, it's adapted the worst out of all the places on my body. The other thing to consider is how fast you're losing weight; if you lose weight slowly, your skin has more time to shrink back to fit your new shape versus losing weight very quickly.

All in all, it's a good idea to try and get down to a healthy and comfortable size before top surgery, but I wouldn't count on being able to do peri.

Another thing to consider is that without T, that fat is less likely to drop from your chest. Testosterone for distribution is much different than that of someone on estrogen, and is more likely to come off the stomach than the chest, I'd think. Granted, genetics plays a strong role in all this as well, and as someone has said, your results can only get better with weight loss.

A few have raised skin elasticity and sagging. You need to lose the weight slowly to combat this, ie no more than 2lbs or else the skin wont pull back. You also cant decide where you'll lose the weight it comes off everywhere or where its most prominent.

I personally am in a similar predicament, the aesthetics of DI do not please me and due to my skin colour the scars will be insanely prominent. HOWEVER there is a solution. After mindless hours of searching the internet I am pleased to say that DI and peri are NOT the only top surgeries you can get! (they are however the most common)

Inverted T - I think looks horrendous, but thats my 2 pence!
Drawstring - Which you should be eligible for
Concentric Circles/Space-ship - Again you could possibly have

These arent available everywhere, so shop around a bit. I think there are a few more as well and new techniques are always being created! Alternatively you could get a breast lift & lipo and then get keyhole but that is expensive, time consuming and will heighten all complications!

Gentle

Nice finding, Gentleboy. Awesome!

Here are some quick views of each alternative:

Inverted T:

Drawstring: Couldn't actually find much on this. The only thing I found said it was a way to describe peri. What did ya find on this Gentleboy?

"In the peri-areolar method, an incision is made along the entire circumference of the areola. The nipple is usually left attached to the body via a pedicle in order to maintain sensation. Breast tissue is then "scooped out" by scalpel, or with a combination of scalpel and liposuction. The areola may be trimmed somewhat to reduce its size. Excess skin on the chest may also be trimmed away along the circumference of the incision. The skin is then pulled taut toward the center of the opening and the nipple is reattached to cover the opening-- much like pulling a drawstring bag closed. Thus, this procedure is also sometimes referred to as the drawstring or "purse string" technique. The nipple/areola may be repositioned slightly, depending on original chest size and the available skin."-http://www.ftmguide.org/chest.html

Conceptric Circles/Spaceship: https://www.youtube.com/watch?gl=US&hl=uk&v=LHoZ0JaOk9M

Hey Escher

Its pretty much what you've got there.
Drawstring is also known as pursestring. Its similar to peri in the sense that they cut around the areolas but they can remove some skin (not a huge amount) and can possibly change the size of the areola (not by much though!!) which isnt usually done on peri. It gets its name from the suture to close it as they pull 2 strings to pull the skin back to the areola to stitch it up.

Drawstring is essentially peri for slightly bigger lads but its not quite concentric circle technique either. They all kinda overlap one another.

Also I would ASK any potential doctors. Just because it's not on their website doesnt mean they dont do it! And if you are one of their first patients to do a particular procedure you can get it cheaper and they tend to put 110% in because you will be the model for their pictures. They're not gonna put a crap job up online are they?!!!!

Gentle

Kicking myself a bit. I cant find some of the original medical journals that I saved.

http://www.lib.okayama-u.ac.jp/www/acta/pdf/63_5_243.pdf

http://www.genderconfirmation.com/surgical-techniques/

http://www.genderconfirmation.com/which-surgery-is-for-me/

Heres a few. There was a really good one which showed you exactly how they do it and had criteria for each type of surgery. If i find it I'll post on here


Gentle

The excess skin was something I had in mind and was concerned about. I'm pretty confident I could get down to at least a B cup again without having any loose skin. The weight loss will definitely be slow since I'm giving myself about a year or two to lower my body fat percentage so that should help too.

Thanks for the videos and links to the other types of top surgery procedures too, those are some great resources and I appreciate you guys taking the time to look them up. I was wondering if something like the drawstring procedure was possible but couldn't find any information on it when I searched. That seems like it would be perfect for me. I'm not completely against the idea of D.I. but I would like to avoid it if I can just because I've always been sensitive about my chest area, it's the thing that bothers me the most and I worry that if I could see the scars or always feel them there my chest dysphoria wouldn't ever completely go away.

I'm already saving up for top surgery so I'll do some shopping around and in the mean time I'll see what kind of results I can get from the weight loss. If I do go with one of the lesser known procedures in the future I'll be sure to document it so other guys can have more information about the other options that are out there although I'm probably getting ahead of myself for now.

Chest-wise, you sound similar to where I was pre-op. Not sure on skin quality and all that, but my surgeon and I had a pretty frank discussion about all of my options, since she has done all of them.

She said she would do a peri, but she was positive that I would need at least one revision to be happy, and she could see doing as many as 2 revisions on top of the original procedure.

A viable option we discussed was doing peri with a lateral extension incision into the armpit area to remove excess skin and tissue. I've only found one of these online, and it was hers. So not sure if it's something she does on the fly or if it's just not as well known of a technique. Again, she said she would do it but would likely need to do one revision.

Ultimately I asked her what she wanted to do and would feel most confident about. She said she was positive she could get it right in one go with a DI. That is what I ended up going with, and I'm 100% happy with the results. Sure, I have very noticeable scarring. But the procedure was quick, my heal time was next to nothing, and I don't have to go back in the future.

I would say take a consult with a surgeon that does both procedures and see what they say. Even if you don't book with them, it's good to have a professional's opinion.